Seventy-three-year-old Kathleen Moran from Drumsna, Co Leitrim, regularly gets up at 4.30am. As a result, her husband, Patrick, who is also in his 70s and is on the waiting list for two knee replacements, gets very little sleep.
“She can be up and down all during the night because she thinks it is morning,” says Kathleen’s daughter Siobhán Doran. The family worry all the time because of Moran’s habit of leaving the house whenever her husband turns his back.
“We refer to it as Mam going ‘MIA’, missing in action,” says Doran. Like her sister, she is a mother of three children and working full time. Both daughters regularly gets telephone calls when Moran goes MIA.
Since the Health Service Executive (HSE) reduced day-care services at St Patrick’s Community Hospital in Carrick-on-Shannon last October the strain on all the family has increased, says Doran.
“Her days were cut from three to two with absolutely no consultation,” she says. “Someone in Dublin signed off on this without knowing the reality for families. I just wish they had to walk in our shoes, even for a day.”
Because the day-care service had previously been cut from five to four days, families and local GPs were shocked when a further cutback to three days was announced in the autumn, with the added bombshell that it would no longer be a nurse- led facility.
The HSE insisted it had liaised with families and said the needs of all clients had been assessed. It added that those who needed nursing care could still get it at St Patrick’s.
But relatives said there was no consultation, and the changes had robbed them of the peace of mind that came with knowing that any medical issues would be quickly detected and addressed.
St Patrick’s was built as a workhouse in the 1840s and when structural defects came under the spotlight in a damning report by the Health Information and Quality Authority (Hiqa) last summer, the community became fearful it might not be re-registered.
As well as anger at the downgrading of day services, there is concern that a long-awaited, purpose-built community hospital may not get the go-ahead for years.
The Friends of St Patrick’s, a lobby group formed last October, said the elderly of the community must not be deceived by “political grandstanding” based on empty promises as the general election campaign kicks off.
Last November, HSE West issued a statement saying it was in discussions with the Department of Health and Hiqa about the replacement of the current hospital, which is home to 85 full-time residents. On a number of occasions the HSE pointed out that it had a site and was "awaiting approval".
But campaigners were angry when Minister for Health Leo Varadkar met them last month and revealed the application had never crossed his desk.
The HSE said it was not at this meeting and so “we cannot comment on what was said”.
A spokesman for the Minister confirmed he had asked for a report from the HSE on the downgrading of the day-care services, but he said the construction of a new hospital was a matter for the HSE.
Campaigner Liam Scollan, the former chairman of Ireland West Airport Knock, said Mr Varadkar was "refreshingly honest", but he asked: "Is it good enough that the unelected agency decides on major matters of policy? Is there such strong public confidence in the competence and accountability of the HSE that a Minister can devolve such power to an agency responsible for the most vulnerable in our community?"
Both of Scollan’s parents ended their days at St Patrick’s and he said that, like many local families, he was grateful for the contentment they found there.
Local GP Dr Kieran Greene said local people felt "misled and disappointed", having been led to believe that sanction for a new hospital was imminent .
Bed numbers at St Patrick’s have been reduced from 112 to 85 in recent years and the Friends of St Patrick’s said the dependency ratio (the ratio of over-65s to the rest of the population) was 57 per cent in Co Leitrim, the highest in Ireland. The ratio of over-65s to the working population, at 23 per cent, was also the highest in the country .
Siobhán Doran said she did not believe there was any chance a new hospital would be built: “It is not going to happen. I believe the HSE has no intention of building a new hospital. Leo Varadkar is the Minister and he said he never saw the proposal.”
Catherine Ryan describes St Patrick's as "my lifeline". Her husband, John (74), had a stroke seven years ago and is paralysed on one side as a result. He has aphasia, which means he cannot communicate. He is in a wheelchair and, while he can eat, his wife has to assist by cutting up his food.
His only social outlet is his visits to the day-care service at St Patrick’s, where he loves watching other men play cards even though he is unable to join in.
“It would be drastic if the hospital closed,” Ryan said. “When John goes in for a week’s respite, I don’t have to be on alert all the time as I know he won’t be calling me. I can go to bed and get up when I like – the simple things in life”.
Fiona Neenan Noone, whose mother Peggy (77), suffered a brain injury when she fell seven years ago, said another cut to the service at St Patrick's would turn her parents' lives upside down. "My dad is 81. It is just the two of them at home, and if the day service is cut again I don't know if she could stay at home."
The Friends of St Patrick’s have written an open letter to politicians and candidates in the election, seeking proposals that are costed and have a timeframe, as well as being “credibly placed” in a health policy.
“We don’t want the elderly care issues of Leitrim, or anywhere else, to be reduced to an exercise in vague promises by government on the one hand, or easy government-bashing opportunities on the other,” said Mr Scollan.